- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,827.30 / $18,278.30 / $32,164.60
| Facility | | $10,827.30 | $18,278.30 | $32,164.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,436.87 / $9,436.87 / $9,436.87
| Facility | | $9,436.87 | $9,436.87 | $9,436.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,975.08 / $10,295.91 / $16,908.04
| Facility | | $6,975.08 | $10,295.91 | $16,908.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,849.15 / $16,848.15 / $23,264.27
| Facility | | $9,849.15 | $16,848.15 | $23,264.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35,361.60 / $35,361.60 / $41,499.83
| Facility | | $35,361.60 | $35,361.60 | $41,499.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.00 / $15,929.40 / $22,753.33
| Facility | | $1,787.00 | $15,929.40 | $22,753.33 |